Cobb County School District
Form IFBGE-1
Empowering Dreams for the Future
PERMISSION TO DISPLAY STUDENT WORK
STUDENT WORK PERMISSION REQUEST
Date: __________
Name and Address of Parent/Guardian/Eligible Student* (PLEASE PRINT):
To Whom It May Concern:
I am writing to obtain permission to use, including publicly display or perform, your/your student's material on the Cobb
County School District Web site.:
Nature of Creation (PLEASE PRINT):
Name of Creator(s) (PLEASE PRINT):_________________
_____________
(___) A photocopy of the material is enclosed.
I wish to use this material in the following work:
Author(s) or Creator(s): __________________________________
Description of Intended Use: _________________________________
I am requesting nonexclusive rights to use this material as part of
and in all future editions and revisions thereof, however these may occur, in any language or medium now known or hereafter
discovered, including, but not limited to: print, microfilm, and electronic media. I am also requesting the right to crop, edit, or treat the
material at my discretion.
Unless you object, the material will be accompanied by the following credit line and copyright notice:
Copyright © (Insert Current Calendar Year) (Insert Student’s Name) (i.e., Copyright © 2008 John Jones)
Thank you for your prompt consideration of this request. For your convenience, a release form is provided below and a signed copy of
this letter is enclosed for your files.
Very truly yours,
Name of Individual Requesting Permission (PLEASE PRINT)
Signature of Individual Requesting Permission
Permission is granted for the use requested above.
Date:
______________________________
Name of Student (PLEASE PRINT)
___________
Signature of Student
___________________
Name of Parent/Guardian (PLEASE PRINT)
Signature of Parent or Guardian
*(If Student is 18 years of age or older, only the Student may authorize the use, public display or performance of his/her work.)